If you have ever worked for a large organisation for at least two years, you will be familiar with this scenario. A new senior manager is appointed. Soon afterwards, the departmental and reporting structure is reorganised. One of the old-hands mutters about how it used to be organised like this before. Then there is a reorganisation of senior management. Soon afterwards, the departmental and reporting structure is reorganised. You join the old hands at the water-cooler to talk about how it used to organised like this, and how it will revert to what you had. Then a new Director is brought into the company from outside, and …..
The simplified improvement model I described in a previous post included a step How do we get to where we want to be? The answer is not to reorganise; the answer is to look at the process. It’s amazing how frequently people think that a reorganisation of itself will cause improvement. Top-down reorganisation is more likely to reduce both effectiveness (the service as seen by the customer, or in the case of a the NHS, by the patient) and efficiency (the budget management and quality of service as seen from within the organisation).
The reasons are obvious. Reorganisations
- are not driven by customer/patient/student/client requirements but by organisational desires
- redirect time, effort and resources which are limited if not effectively finite
- do not improve morale or commitment. At best they are neutral
- distract from the delivery of service and improving that delivery
- result in lost knowledge as people move roles
- are often not project-managed effectively making the transition itself inefficient
Imagine instead an organisation which is based on the following principles:
- A long-term philosophy, which creates a learning organisation
- The right process will produce the right results
- Develop your people and your partners
- Solving root problems drives organisational learning
Within the long-term philosophy of such an organisation, the devolvement of problem-solving – removing impediments to the efficiency and effectiveness of the service – to employees who are continuously developing and improving their own work would create a virtuous cycle of service improvement from the bottom-up.
The contrasts between this hypothetical organisation and the NHS envisaged by the top-down reorganisation in the Coalition’s Health and Social Care Bill are stark, and between this hypothetical organisation and the NHS which will result from the bill will most probably be even more extreme. The NHS after this bill becomes law will
- dispense with a long-term philosophy on the assumption that the cumulative results of short-term, market-led changes will be long-term improvement
- ignore process for multiple internal reorganisations driven by cost-efficiencey and maximising profit
- treat people as units of cost within a profit-model and prevent collaboration
- ignore root problems by trusting to competition
The Prime Minister’s claim that there would be no top-down reorganisation of the NHS was possibly disingenuous but almost certainly ill-thought through: the Lansley “reforms” put into motion reorganisation through market forces, an unplanned and medium-to long-term reorganisation driven by market competition resolved only when the NHS becomes a privately owned monopoly or oligopoly. In doing this, Lansley was being consistent in setting aside the accountabilities and responsibilities of the Secretary of State for Health for two reasons: once the bill becomes law change will not be planned, and the Coalition’s free-market ideology dictates that a market will not work perfectly if government interferes.
In the hypothetical organisation built around the four principles (above) change is replaced with improvement; because that improvement is devolved to employees, leadership provides direction within the long-term philosophy of the organisation and the organisation becomes flexible and responsive to local situations. The simplified improvement cycle introduced in the previous blog is scaled to the whole organisation which is collaborative, not competitive with itself.
Roughly every five years the UK electorate is given the opportunity to vote for a top-down reorganisation of the personnel in Government and often (defying experience) obliges. The often unintended consequence is that the electorate gives to itself significant change to public service, either because the incoming management has its own view on what “needs to be done” or, as with the Tories and Orange Book Liberal Democrats, because the incoming government has an unshakeable faith that government cannot deliver efficient and effective service, but that competitive markets not only can, but will. The impact of change between governments has been aggravated by the increased role of private advisors and decreased role of the Civil Service, which itself has been redirected from providing continuity and advice to driving “change”.
The Health and Social Care Bill is a product of a dysfunctional process being exploited by a Government which does not believe in government and has a vested interest in its diminishment, but what are the root causes of this and how can the problem be solved?.
Footnote: Actually, most of us know that in target-driven organisations, reorganisations are really about shaking out the required number of jobs to cut costs, together with those employees who didn’t hit their most recent targets. Pour encourager les autres.